Eczema Treatment Plan
Treatment plan to be
completed by nursing and
dressing instructions -
disposable towel and crepe bandage
Cool ways to beat eczema video
Eczema is a common skin condition affecting ten to twenty per
cent of children. The exact cause of eczema is not known. However
if there is a history of eczema, asthma or hay fever in the family,
your child is more likely to develop one of these conditions.
Unfortunately there is no cure for eczema, although there are many
ways to keep it under control. Approximately fifty per cent of
children will no longer be troubled by eczema by two years of age
and eighty five per cent by five years of age.
Eczema is a red, hot, dry and itchy rash that can affect one or
many areas on the face and body and it can be mild, moderate or
severe. There are often scratch marks on the skin because of the
itch. These areas may become infected with bacteria and this can
worsen the eczema. If there is an infection, your child may need a
course of oral antibiotics.
When the rash begins in the first few months of life it normally
affects the face. The cheeks and chin become red, dry, hot and
itchy. This is made worse by dribbling, hands touching the face and
mouth and saliva irritating the skin. The scalp and facial blood
vessels are dilated quickly if baby is overheated. At this age
eczema may also affect the trunk and limbs, but the changes in
these areas are not usually as severe. As the child becomes a
toddler the eczema is less likely to affect the face and more
likely to be present on the limbs and trunk. The napkin area is not
usually affected. When the child becomes school aged the eczema
tends to affect the hot areas of the body, such as the flexures of
the neck, elbows, knees and buttocks for similar reasons.
HEAT, DRYNESS and PRICKLE aggravate eczema. It is important you
are aware of these three factors and remove them from your child's
environment. You should keep your child COOL, well MOISTURISED and
in LOOSE, LIGHT COTTON CLOTHING and BLANKETS.
The skin of a child with eczema is very hot, and heat increases
the itch. There are many things that can make your child hot.
Clothing can aggravate eczema. It is best to dress your child in a
couple of thin layers rather than a thick layer, as it is easier
and more effective to remove the top layer of clothing to suit the
environment and stop your child becoming hot and itchy than it is
to change the environmental temperature.If your child is
participating in physical activities, take a layer of clothing off
before doing so to avoid over heating. Educate your child and
his/her teachers about this too.
A hot bath can heat your child and cause him/her to become
itchy. Bath your child once a day in tepid water adding one capful
of bath oil to the bath and use this as a soap substitute. Soaps
and some pinetar preparations can be drying to the skin. Your child
should be bathed at least two hours before bedtime. The bath should
be a pleasurable experience; toys in the
bath are a good idea.
Travelling in the car can be an unpleasant experience when your
child has eczema. The heat generated in the car can cause the child
to become hot and itchy. Sunlight shades are beneficial in reducing
the heat of the car. Heaters should be used minimally or switched
off. It is important to try and predict the occurrence of
overheating and also avoid clothing that may be applying pressure
or trapping heat. Avoid long car trips if possible and dress your
child for the car ride not for the destination. After the trip,
assess the heat and itch of your child and institute the
appropriate treatments, such as, removing clothing and if needed
applying a wet dressing. If a long journey is unavoidable, ensure
you take many breaks, use air-conditioning and apply wet dressings
and cool compressing often. If your child scratches in the car,
canvas armbands may need to be used.
Children often itch more at night
because they get hot under the bed-covers, the skin has more
contact with clothing and seams and many children are in a habit of
waking. If the eczema is not in good control, children may have
difficulty sleeping and may wake a few times each night. Children
with eczema should ideally sleep in their own beds, so as not to
overheat. Soft cotton or silk sheets and at most one thin cotton
blanket are appropriate bed linen. Woollen underlies or blankets,
plastic mattress protectors, or doona covers should not be
Frequent waking and scratching at night and blood on the sheets
in the morning are signs that your child will need a wet dressing
just before bed. Wet dressings improve the sleep pattern of
children with eczema, by keeping them cool and reducing the itch.
Your doctor may prescribe a sedative at night until the eczema and
sleeping pattern improves. Antihistamines should NOT be used
routinely, or for children under two years of age.
Your child should wear one to two thin cotton layers to school.
Woollen jumpers will make them hot and itchy. It is important to
educate your child's teacher about factors that worsen eczema. Ask
them not to sit your child next to the heaters. If your child is
itchy at school they should apply moisturiser and a cool towel to
the itchy area. The teacher should not make a fuss in front of the
class. However, they should be aware to remind your child to apply
treatment in a private place. On hot days, your child may wet
his/her clothes to reduce the heat and itch of the skin.
The home should be kept cool. Air blowing heaters are the most
drying to the skin. It is best if your child's bedroom is not
heated. Remember, your child feels hotter and is more affected by
heat than you. It is better to apply another layer of clothing
rather than it is to turn up the heater. Do not be concerned about
your child catching a "cold" from being under dressed as this is an
old wives' tale.
The skin should be moisturised many times a day to help with
this dryness. There are many things that can dry the skin like
water, air-blowing heaters, cleaning agents, soap, swimming and the
environment, such as Victoria's dry winds in summer and winter.
Your child's skin will be dryer in the winter as the humidity is
lower and heaters are used more. You may notice the eczema will
improve on a tropical holiday.
Children with eczema usually have very dry skin, which worsens
the itchiness. Moisturisers are used to prevent the skin from
drying and they should be used frequently, and are very important
in the management of eczema. Moisturisers can be used alone and can
also be applied over the steroid and tar creams and under wet
dressings. They are applied as often as required to prevent the
skin from becoming dry, which may be three to five times a day
every day. And are applied all over the face and body and not just
to the areas of eczema. They should be applied on a regular basis
and continued until your child's eczema has resolved. Your child
should be encouraged to participate in and recognize the need for
the application of moisturisers. If any creams irritate the skin,
stop its use, apply a bland moisturiser, preferably in an ointment
form and contact your local doctor or dermatologist if it
continues. Some of the greasier moisturisers may cause blocked
pores. The blocked pores look like small pimples. If this occurs,
change the moisturiser to a cream or lotion base.
Detergents aggravate eczema skin and dry it by removing oil. Try
to use Lux or Velvet soap in your washing machine and ensure a good
rinse. Crepe bandages used for wet dressings may be washed in the
washing machine. Disposable towels used for wet dressings should
not be washed with detergents or soaps. Dry garments in a tumble
dryer if possible, as clothes tend to dry softer than if hung on
the line. Try to avoid baby wipes, as they tend to dry and irritate
Yes, your child is able to swim, however if they are having a
flare of their eczema your doctor or nurse may suggest your child
may need to stop swimming until the eczema improves. Prior to
swimming apply moisturiser to the skin. After swimming remove the
chorine/salt water in a cool fresh water shower with bath oil, and
then apply a moisturiser before dressing.
Dummies may aggravate eczema around the mouth, chin and chest
areas. This is because saliva wells up under the dummy and
irritates the skin. Food products may also aggravate the skin
around the mouth. This is not necessarily an allergy and the area
is best protected with a thick ointment moisturiser. Eczema often
gets worse during teething.
Clothing can worsen eczema especially
when it has a "prickly" feeling. Large fibres, especially seams,
wool, stitching, tags, frills and lace edges will make your
child feel itchier. Small cotton or silk fibres are the fabrics of
choice for clothing or bed linen. You need to be aware if your
child is becoming itchy from a garment. If the seams are harsh turn
the garment inside out and unpick the tags, or line areas with a
piece of silk. Undergarments made of silk such as boxer shorts are
popular with children with eczema for day and night time use. If
you are unsure about a piece of clothing feel it. If it feels
slightly rough or prickly to you it will be very irritating to your
Your doctor may prescribe a cortisone cream or ointment for
areas of eczema on the face and body. These ointments help to
settle inflammation and redness of eczema. Cortisone is a natural
body hormone and if used as prescribed carefully by your doctor, is
completely safe. Avoid strong cortisone ointments on the face and
flexures, hydrocortisone is preferred for these areas. Ointments
are preferred, as they are more moisturising than creams.
When using cortisone ointments apply a layer of the cortisone to
the red areas. Cortisone ointments are best used once or twice a
day only when the skin is red. Reduce its usage as the eczema
settles. Cortisone ointments come in different strengths and your
doctor should discuss with you what strength is appropriate for
Foods are not the single cause or cure of eczema. Only about ten
per cent of children with eczema have proven allergies to diet.
However if most of these children with food allergies stopped
eating the foods they are allergic to they would still have some
eczema and require the same topical treatments as other children
with eczema. Children who have allergies to foods may be extremely
itchy without a lot of redness. Other children
with allergies to foods may develop a hive like reaction to foods
immediately or within two or more hours after food. These reactions
tend to start in the early months of life and are seen less often
as children grow out of them. If you are concerned your child may
have food allergies, keep a food diary and the reactions to these
foods to show to your doctor. Some foods that may cause allergies
are; egg, dairy, seafood and nuts, beef, chicken, wheat, citrus
fruit and junk food. When starting a new food give only a small
amount of each new food, do not give large amounts too quickly.
Breast-feeding is the best form of milk for the baby with eczema.
Do not restrict your child's diet without consulting a doctor.
It would appear that the house dust mite can flare eczema.
However, the degree of importance of the irritation of the house
dust mite is controversial. Many people without eczema are allergic
to house dust mite and many eczema sufferers do not improve greatly
when they use anti-dust mite measures. From our experience, we
think that house dust mite probably plays a minor role in most
children's eczema, but occasionally can be more important. Please
discuss this issue further with your doctor if you are
Armbands/splints may be required at
times to stop your child from scratching. Armbands are better than
mittens and allow the skin time to heal and improve. They are
useful at night and in the car, or when you cannot supervise your
child and when the itch is worse. Armbands should not be used all
day long. During the day if you can, distract your child with
activities to reduce scratching. Splints and dressing equipment are
available for purchase at the Equipment Distribution Centre at the
Royal Children's Hospital, phone 9345 5325.
Your child should continue to have all
immunisations unless told otherwise by your doctor. If your child
is allergic to eggs there are no contra-indications for your child
being immunised for measles, mumps or rubella. Although, if the
reaction is severe, it is best to have the immunisation performed
by your local doctor or immunisation clinic, and your child should
not have the flu or yellow fever immunisation. Contact your General
Practitioner if you have any questions.
Wet dressings are important for the effective treatment of
eczema. Wet dressings are essential when your child is itchy and
hot and if they are waking from the itch. Your child may need a wet
dressing if they itch and scratch during the night, if there is
blood in the sheets in the morning, and if the eczema is still
present despite treatment with cortisone ointments, moisturisers
and bath oils. You will need to apply wet dressings at night for a
few nights to get it under control. Initially they may be required
during the daytime but should be changed as soon as they are dry.
Early use of wet dressings will reduce the amount of cortisone
creams needed to control the eczema substantially. Parents who have
used wet dressings, generally express great satisfaction with the
Wet dressings may be applied as often as required to any area of
the body with eczema, for example, the elbow or the knee. The wet
dressings will dry, please try not to leave the dressings on dry as
dry dressings can irritate the skin by causing it to become hot,
dry and itchy. Please note the water used in the wet dressing does
not have to be cold. Wet dressings cool the skin by the water
evaporating just like sweat.
No. It is not advised to wet dress the head, neck or trunk.
Instead of using a wet dressing use cool compressing to areas on
the face, head or other areas on the body for immediate relief. Wet
cool compresses can be applied to the neck as a scarf (only knot
once), and a wet bandana can be applied to the head. The scarf and
bandana should be applied only under supervision. For the trunk, it
is advised for you to apply a wet T-shirt or singlet over a layer
of moisturiser if the trunk is red or itchy. A dry T-shirt can be
applied over this.
Wet dressings and cool compressing should not be used as a last
resort treatment, when your child's eczema is at its worse. Use
these helpful techniques as soon as the eczema flares rather than
leaving it until the eczema becomes severe and infected. Think of
the wet dressing and cool compressing techniques as first line
treatments when the eczema flares or becomes itchy.
If your child initially refuses to allow you to apply wet
dressings or cool compressing, persist slowly with these techniques
to keep your child's eczema under control. Teach your child the
value of wet dressings and encourage them to participate with the
application or encourage your child to apply wet dressings to their
doll. Rewards are important in encouraging the application and
continuation of wet dressings and eventually your child will
understand the benefits.
When eczema is infected it is often crusted, the crusts are
normally yellow in colour, there may also be areas of weeping, and
this is often a sudden change in the normal eczema. Your child may
also be itchier than usual and the skin may be painful to touch,
when severe your child may find it difficult to extend their elbows
or knees. Children with eczema may often get secondary infections
if the eczema is not under control. The eczema becomes infected
because children scratch and the skin is then broken. One small
area of infection can flare the other areas of eczema.
The cold sore virus can also infect eczema.A sudden onset of
clusters of blisters will result from this infection, which
requires special treatment. Your child should avoid close contact
with people with cold sores and school sores. If you think the
eczema is infected you should go to your family doctor and have the
infected areas swabbed. If your doctor thinks the eczema is
infected he/she will start your child on a course of antibiotics.
If there are areas of crusts it is very important to remove them,
as if you do not remove the crusts you are not treating the
infection properly as antibiotics cannot get to the crusts to treat
Antiseptic washes are important in the maintenance and treatment
of eczema infections. They help to reduce the bacteria on the skin.
When your child scratches and breaks the skin's barrier the skin
may become easily infected. By using an antiseptic wash the numbers
of bacteria are reduced this helps to reduce the amount of skin
infections. When the skin is infected it can be more difficult to
keep under control. On the other hand some antiseptics can irritate
the skin so it is important to use these only if directed by your
Some children with eczema have learnt that if they scratch they
will get what they want or attention from their parents. It is
encouraged that parents do not give in to their child's scratching
behaviour. Scratching behaviour is often worse when the child is
crying, stressed, upset or having a tantrum to get their own way.
Treat the tantrum first and later deal with the eczema. When
scratching gets attention the behaviour is more likely to be
repeated. Avoid always telling your child to stop scratching or
giving in; rather use distraction activities, especially ones using
your child's hands. Distraction is always a good way to stop
children scratching by taking their mind off the skin and itch.
Positive language should be given as often as possible, never use
words such as "bad skin". It is common for childrens' behaviour to
deteriorate with the eczema. When the eczema is under control the
behaviour usually improves. This can be due to many factors such as
itchy, hot skin, and lack of sleep. Seek help and talk to your
treating doctor or nurse if your child's behaviour is
When eczema is not well controlled, children may wake many times
a night. This vicious circle can lead to the eczema and sleep
pattern deteriorating more, the eczema becoming secondarily
infected, and minimal or no weight gain. Poor weight gain can be
attributed to poor sleep and feeding. Short and broken feeds can be
associated with itch, this can produce broken feeding patterns. A
child needs to sleep and feed well to help them gain weight and
grow. To help your child sleep well it is important to keep them
cool and apply wet dressings just before bedtime. You will need to
apply wet dressings at bedtime until the eczema is under control
and your child is sleeping well, the weight will also increase with
this improvement. If the eczema is under control and the weight has
not increased it is important to visit you family doctor for
consultation on this matter.
As you can appreciate, eczema is influenced by many factors.
Just as the skin is improving it may become worse again for no
clear reason. Unfortunately this tends to happen with eczema.
Remember to treat the flare as soon as possible with wet dressings,
cool compressing and cortisone creams and maintain it with
moisturisers and bath oils. Eczema takes a lot of time and
attention to keep it under control, however it is easier to keep it
under control than to manage it when it is infected or severe.
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Telephone +61 3 9345 5522
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Victoria 3052 Australia